Heroin resurgence outruns treatment

Effective long-term care often not covered by private insurance

Jordan Carle, Times Union

By Jordan Carleo-Evangelist

Updated 9:51 pm, Tuesday, December 17, 2013

Dr.Michael Dailey, at right, medical director for Colonie EMS presents members of the NYS Democratic Conference with overdose prevention rescue kits during a public forum on increase in heroin use Tuesday Dec. 17, 2013, in Albany, NY. (John Carl D'Annibale / Times Union)

Fifty-four years ago, Father Peter Young warned state lawmakers about the ravages of heroin in some of the poorest, most desperate corners of Albany's inner city.

Their answer: "That's only a Harlem problem, father — don't worry about it," the state Senate's chaplain recalled Tuesday.

But now the drug is making a deadly resurgence in the region's suburban and rural communities, and gaining headlines with an unusual twist: The poor are at times in a better position to get treatment than the kids from middle-class suburban families who have increasingly fallen under the spell of the highly addictive narcotic.

The problem, several witnesses told state senators Tuesday, is that private insurers often refuse to cover the most effective form of treatment: long-term inpatient care.

Albany County Probation Officer Darcy Katz told lawmakers that "the insurance barrier is just so high" that she sometimes urges young addicts to move out their parents' homes so they can qualify for Medicaid — the public insurance program for the poor — to get the treatment they need.

"That's the best chance of success that I've seen," Katz said.

The three-hour fact-finding session at the Capitol complex, headlined by two grieving mothers who recently lost their children to heroin overdoses, came less than a week after a 17-year-old Shenendehowa High School student was charged with allegedly injecting a 15-year-old classmate with the drug in the boys' locker room.

If there is an upside to that shocking case, Colonie Police Chief Steven Heider told the panel, it's that it will force the community to confront an ugly problem that police, paramedics, emergency room staff and addiction specialists have seen brewing for several years.

"Suburban people have a habit of closing their eyes," Heider said. "The obituaries in the paper aren't doing it, and we need the public involved."

One of those obituaries was for Laree Farrell-Lincoln, who died of an overdose in March less than a week shy of her 19th birthday. She had only been using heroin, which local police say is cheaper and more potent than ever, for about four months.

One of the roadblocks that her mother, Patricia Farrell, initially hit when trying to get her daughter treatment was that her insurance company initially refused to cover more than two days of detox.

"They weren't willing to cover inpatient," Farrell said. "How do you get an addict to complete outpatient care?"

The federal Affordable Care Act, otherwise known as Obamacare, requires insurance coverage for drug treatment, but what exactly that requirement means in terms of actual programs offered by individual insurers is not explicitly laid out.

"It's the opposite of what's usually true — that poor people get the requisite coverage here and kids from the suburbs might not," said state Sen. Neil Breslin, a Bethlehem Democrat and the ranking member of the Senate's Insurance Committee, who presided over the forum run by the chamber's minority Democrats.

Parker said the issue has been personal for him since his brother, who used heroin in the 1980s, died from AIDS — a disease long associated with intravenous drug use.

Breslin said the Legislature can use its power to scrutinize and interpret what is covered by insurance policies, and "make sure that we can contact insurance companies to say, 'Don't be denying these (claims for inpatient care).'"

If that doesn't work, he said, lawmakers can "look to see if that's something that we need to add on to be a mandate" — similar to how health insurers in New York in 1997 were required to cover most chiropractic care.

"Too often, a crisis exists before legislators are able to do anything about it," Breslin said.

Other witnesses backed programs — such as those at Catholic Charities and Albany Medical Center — to boost access to naloxone, a drug that can be administered nasally by friends and family to reverse the effects of acute overdoses involving opiods like heroin and prescription painkillers, which experts say have increasingly been a gateway to heroin for suburban youth.

A pilot program in parts of New York that expanded access to naloxone from paramedics to providers of lower levels of life support, like emergency medical technicians, helped reverse some 200 overdoses in its first year, said Dr. Michael Dailey, an emergency room physician at Albany Medical Center Hospital and medical director for both the pilot program and Colonie EMS.

Based in part on that success, the state Health Department this fall approved the use of naloxone, also known as Narcan, by basic life support providers, which covers most if not all community ambulance squads.

"We need to get naloxone out there," said Peter Berry, deputy chief of the Colonie EMS Department. "This is a medication that can save lives (when) put into the right hands."

Brenda Auerbach, whose 20-year-old son, Jeremiah, overdosed in October of last year, said she wished she had access to naloxone when she found him fatally stricken in the bathroom.

Non-medical personnel have been allowed to administer naloxone in New York since 2006, but raising awareness about the drug, access problems and the need to train people to administer it correctly has so far limited its reach.

"It would have been an option," Auerbach said. "Instead of me frantically waiting for the ambulance to get there."